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Background Hyperspectral Imaging (HSI) is a reliable and safe imaging method for taking intraoperative perfusion measurements. This is the first study translating intraoperative HSI to an in vivo laparoscopic setting using a CE-certified HSI-system for minimally invasive surgery (HSI-MIS). We aim to compare it to an established HSI-system for open surgery (HSI-Open). Methods Intraoperative HSI was done using the HSI-MIS and HSI-Open at the Region of Interest (ROI). 19 patients undergoing gastrointestinal resections were analyzed in this study. The HSI-MIS-acquired images were aligned with those from the HSI-Open, and spectra and parameter images were compared pixel-wise. We calculated the Mean Absolute Error (MAE) for Tissue Oxygen Saturation (StO2), Near-Infrared Perfusion Index (NIR-PI), Tissue Water Index (TWI), and Organ Hemoglobin Index (OHI), as well as the Root Mean Squared Error (RMSE) over the whole spectrum. Our analysis of parameters was optimized using partial least squares (PLS) regression. Two experienced surgeons carried out an additional color-change analysis, comparing the ROI images and deciding whether they provided the same (acceptable) or different visual information (rejected). Results HSI and subsequent image registration was possible in 19 patients. MAE results for the original calculation were StO2 orig. 17.2% (± 7.7%), NIR-PIorig. 16.0 (± 9.5), TWIorig. 18.1 (± 7.9), OHIorig. 14.4 (± 4.5). For the PLS calculation, they were StO2 PLS 12.6% (± 5.2%), NIR-PIPLS 10.3 (± 6.0), TWIPLS 10.6 (± 5.1), and OHIPLS 11.6 (± 3.0). The RMSE between both systems was 0.14 (± 0.06). In the color-change analysis; both surgeons accepted more images generated using the PLS method. Conclusion Intraoperative HSI-MIS is a new technology and holds great potential for future applications in surgery. Parameter deviations are attributable to technical differences and can be reduced by applying improved calculation methods. This study is an important step toward the clinical implementation of HSI for minimally invasive surgery.

Intraoperative near-infrared fluorescence angiography with indocyanine green (ICG-FA) is a well-established modality in gastrointestinal surgery. Its main drawback is the application of a fluorescent agent with possible side effects for patients. The goal of this review paper is the presentation of alternative, non-invasive optical imaging methods and their comparison with ICG-FA.The principles of ICG-FA, spectral imaging, imaging photoplethysmography (iPPG), and their applications in gastrointestinal surgery are described based on selected published works.The main applications of the three modalities are the evaluation of tissue perfusion, the identification of risk structures, and tissue segmentation or classification. While the ICG-FA images are mainly evaluated visually, leading to subjective interpretations, quantitative physiological parameters and tissue segmentation are provided in spectral imaging and iPPG. The combination of ICG-FA and spectral imaging is a promising method.Non-invasive spectral imaging and iPPG have shown promising results in gastrointestinal surgery. They can overcome the main drawbacks of ICG-FA, i.e. the use of contrast agents, the lack of quantitative analysis, repeatability, and a difficult standardization of the acquisition. Further technical improvements and clinical evaluations are necessary to establish them in daily clinical routine.

Zusammenfassung Hintergrund Die Fluoreszenz-Angiografie (FA) mit Indocyanin-Grün (ICG) und das Hyperspektral-Imaging (HSI) sind neue intraoperative Visualisierungsmöglichkeiten in der Abdominal-, Gefäß- und Transplantationschirurgie. Ziel ist es, damit die postoperative Morbidität und Mortalität im Sinne der Präzisionschirurgie und Patientensicherheit zu reduzieren. In diesem Artikel werden aktuelle Daten und das zukünftige innovative Potenzial der Echtzeit-Bildgebungsmodalitäten hervorgehoben. Methoden Das Prinzip der neuen „Imaging“-Verfahren und deren klinische Anwendungen werden aufgearbeitet mit Blick auf Anastomoseninsuffizienzen, die die folgenschwersten Komplikationen in der gastrointestinalen Chirurgie nach onkologischen Resektionen darstellen. Ergebnisse Während die FA die Gabe eines Fluoreszenzfarbstoffs erfordert, ist HSI völlig kontaktfrei und nichtinvasiv. Beide Methoden können in „Real-Time“-Applikation physiologische Gewebeeigenschaften, zudem die FA auch dynamische Phänomene, erfassen. Die Verfahren dauern nur wenige Sekunden und stören den operativen Ablauf nicht wesentlich. Sie sind hinsichtlich ihrer Aussagekraft für eine mögliche Änderung der operativen Strategie als komplementär zu betrachten. Unsere eigenen Weiterentwicklungen der Modalitäten liegen insbesondere im Bereich der Datenvisualisierung sowie der automatischen Datenanalyse unter Einsatz der künstlichen Intelligenz (KI) und der Miniaturisierung der bisherigen Geräte für einen zukünftigen Einsatz in der Endoskopie, der minimalinvasiven und der roboterassistierten Chirurgie. Schlussfolgerung Insgesamt ist die Zahl der Studien im Forschungsfeld der intraoperativen Bildgebung zurzeit noch sehr limitiert. Ob diese neue Art der Präzisionschirurgie im „Hightech“-OP mit der Kombination aus HSI, FA und Robotik zu einer verbesserten Patientensicherheit durch Minimierung der postoperativen Morbidität und Mortalität führt, muss in weiterführenden multizentrischen Studien evaluiert werden.

Hyperspectral Imaging (HSI) provides surgeons intraoperative colored images of abdominal organgs detecting the perfusion and oxygenation. Limiting factors such as missing colour video, camera size, and long acquisition times have been overcome in the first CE-certified HSI-System for Minimally-Invasive Surgery (HSI-MIS; TIVITA® Mini Endoscopy Edition, Diaspective Vision GmbH, Am Salzhaff, Germany). This system was evaluated in-vivo during surgery and compared with an HSI-System for Open Surgery (TIVITA® Tissue, Diaspective Vision GmbH, Am Salzhaff, Germany). Hyperspectral imaging was performed with both the HSI-MIS and the HSI-System for Open Surgery at the Region of Interest. 19 patients undergoing gastroenterologic resections were included in the study. The images acquired with the HSI-MIS were registered onto the images from the open HSI system, and spectra, as well as parameter images, were pixel-wise compared. Violin plots were created for Tissue Oxygen Saturation (StO2), Near-Infrared Perfusion Index (NIR PI), Tissue Water Index (TWI) and Organ Hemoglobin Index (OHI). The raw data was analyzed using a partial least squares (PLS) and compared with the parameters as calculated by the original software The MAE results for the in-vivo evaluation were: StO2: 17.4% ± 7.6%, NIR PI: 16.3 ± 9.4, OHI: 14.3 ± 4.5, and TWI: 18.3 ± 7.8. The results obtained by PLS were StO2: 11.1% ± 3.9% (improved by 36%), NIR PI: 9.5 ± 5.8 (improved by 42%), OHI: 10.7 ± 2.7 (improved by 25%) and TWI: 9.6 ± 4.3 (improved by 48%) Laparoscopic hyperspectral imaging during minimally invasive procedures shows promising results. Parameter deviations might be attributable to technical differences and on how the parameters are calculated. The PLS method has shown significant improvement compared to the original calculation.

Hyperspectral imaging (HSI), as recently applied in medicine, is a novel technology combining imaging with spectroscopy. It might be used to identify, classify and discriminate malignant and non-malignant cells of histopathologic specimens. HSI allows the determination of a spectrum between the visual and near-infrared light (500-1000 nm). After surgical resection, specimens (n = 96) of Barrett’s cancer were fixed in 4% formaldehyde and slices were conducted (3 μm), which were stained with hematoxylin and eosin (HE). Differences in the absorbance of squamous epithelium and esophageal adenocarcinoma (EAC) cells were determined at eosin’s and hematoxylin’s maximal absorption of 530 nm and 590 nm. A classification algorithm, which combines a multilayer perceptron (MLP) with a Gaussian filter and data reduction based on principal component analysis (PCA) was used for discrimination. For the first time in literature, we were able to analyze esophageal adenocarcinoma, tumor stroma and squamous epithelium cells by HSI. For both, the squamous epithelium and the esophageal adenocarcinoma cells, the intragroup variances were quite low. A set of 20 specimens was used in a testing phase, which showed MLP by using reflectance data to provide the best results. Leave-one-patient-out-cross validation for all 96 specimens showed an accuracy of 77% with a sensitivity of 87% and a specificity of 72% for EAC determination and visualization. Squamous epithelium and EAC cells show specific spectral alterations due to their HE-staining, when measured by HSI. However, the training algorithms need further validation to foster a semi-automatic decision-making process in histopathological tumor cell identification.

Colon conduit is an alternative option for the reconstruction after oesophagectomy. The impact of using Hypersepctral Imaging (HSI) has been already proved in evaluating the perfusion of gastric conduit, but not in the case of using colon conduit. This is the first study described a new tool evaluating the perfusion of colon conduit and allowing us as esophageal surgeons to choose the appropriate side (left or right) of colon conduit and anastomosis site intraoperatively In 10 patients, who underwent reconstruction with a long segment colon conduit after oesephagectomy from 01.01.2018 till 01.04.2022. HSI was recorded in 8 of these patients at the root and tip of colon conduit after clamping the colic middle vessels allowing us to evaluate the perfusion and the appropriate side of colon conduit (Figure 1) Anastomosis Leakage (AL) grad I° was detected only in one patient (12.5%) of all included patients (n=8). There was no conduit necrosis in all of these patients. Re-anastomosis was necessary only in one patient. There were no need to conduit resection and esophageal diversion or to stent placement in all of included patients. Furthermore, there were no change of the selected side of colon conduit intraoperatively HSI is a promising novel intraoperative imaging tool to evaluate the perfusion of colon conduit objectively, which helping us to make the right decision regarding the side of the colon conduit as well as the site of the anastomosis intraoperatively.

OBJECTIVE Aim of our study was to test a non-invasive Hyperspectral Imaging (HSI) technique as an intraoperative real time assessment tool for deceased donor kidney quality and function in human kidney allotransplantation. SUMMARY BACKGROUND DATA HSI is capable to deliver quantitative diagnostic information about tissue pathology, morphology and composition, based on the spectral characteristics of the investigated tissue. Since tools for objective intraoperative graft viability and performance assessment are lacking, we applied this novel technique to human kidney transplantation. METHODS Hyperspectral images of distinct components of kidney allografts (parenchyma, ureter) were acquired 15 and 45 minutes after reperfusion and subsequently analyzed using specialized HSI acquisition software capable to compute oxygen saturation levels (StO2), near infrared perfusion indices (NIR), organ hemoglobin indices (OHI) and tissue water indices (TWI) of explored tissues. RESULTS Seventeen kidney transplants were analyzed. Median recipient and donor age were 55 years. Cold ischemia time (CIT) was 10.8 ± 4.1 hours and anastomosis time was 35 ± 7 minutes (mean ± SD). Two patients (11.8%) developed DGF. CIT was significantly longer (18.6 ± 1.6) in patients with DGF (p < 0.01). Kidneys with DGF furthermore displayed significant lower StO2 (p = 0.02) and NIR perfusion indices, 15 min after reperfusion (p < 0.01). Transplant ureters displayed a significant decrease of NIR perfusion with increased distance to the renal pelvis, identifying well and poor perfused segments. CONCLUSION Intraoperative HSI is feasible and meaningful to predict DGF in renal allografts. Furthermore, it can be utilized for image guided surgery, providing information about tissue oxygenation, perfusion, hemoglobin concentration and water concentration, hence allowing intraoperative viability assessment of the kidney parenchyma and the ureter.

Acute mesenteric ischemia is a life-threatening acute condition, which requires an interdisciplinary approach, including vascular recanalization and surgical treatment. Visual evaluation of intestinal perfusion might be misleading, and therefore, additional tools are necessary to reliably be able to resect the ischemic intestine. Hyperspectral imaging (HSI) has been shown to be feasible and safe for real-time assessment of tissue perfusion in visceral surgery but has never been used in cases of acute mesenteric ischemia. Therefore, we applied HSI in acute mesenteric ischemia to evaluate it for potential aid in the objectively discriminating ischemic and well-perfused intestine during explorative laparotomy.We recorded HSI measurements in 11 cases of acute mesenteric ischemia during explorative laparotomy. We evaluated the recorded images for macroscopic visual perfusion quality and divided it into three groups. Of those three groups, we calculated and compared the HSI indexes of tissue saturation, near-infrared perfusion index, organ hemoglobin index, and tissue water index, as well as the reflectance spectra.We found significant differences in tissue saturation (0.7% versus 0.45%; P = 0.002) and near-infrared perfusion index (0.58 versus 0.23; P 0.001) in poorly perfused intestinal segments compared with the viable intestine. Furthermore, we could detect an increasing peak at 630 nm of the reflectance spectra in less viable tissues, indicating a maximum in necrotic tissues. We attributed this peak to an increase in met-hemoglobin content in necrotic tissues, which is supported by the increase in the HSI organ hemoglobin index.HSI is able to discriminate tissue perfusion in acute mesenteric ischemia reliably and therefore might be helpful for resection. In addition, HSI gives information on tissue viability via reflectance spectra.

Background Thyroidectomy is one of the most commonly performed surgical procedures. The region of the neck has a very complex structural organization. It would be beneficial to introduce a tool that can assist the surgeon in tissue discrimination during the procedure. One such solution is the noninvasive and contactless technique, called hyperspectral imaging (HSI). Methods To interpret the HSI data, we implemented a supervised classification method to automatically discriminate the parathyroid, the thyroid, and the recurrent laryngeal nerve from surrounding tissue(muscle, skin) and materials (instruments, gauze). A leave-one-patient-out cross-validation was performed. Results The best performance was obtained using support vector machine (SVM) with a classification and visualization in less than 1.4 seconds. A mean patient accuracy of 68% ± 23% was obtained for all tissues and material types. Conclusions The proposed method showed promising results and have to be confirmed on a larger cohort of patient data.

Intraoperative imaging assists surgeons during minimally invasive procedures. Hyperspectral imaging (HSI) is a noninvasive and noncontact optical technique with great diagnostic potential in medicine. The combination with artificial intelligence (AI) approaches to analyze HSI data is called intelligent HSI in this article.What are the medical applications and advantages of intelligent HSI for minimally invasive visceral surgery?Within various clinical studies HSI data from multiple in vivo tissue types and oncological resections were acquired using an HSI camera system. Different AI algorithms were evaluated for detection and discrimination of organs, risk structures and tumors.In an experimental animal study 20 different organs could be differentiated with high precision ( 95%) using AI. In vivo, the parathyroid glands could be discriminated from surrounding tissue with an F1 score of 47% and sensitivity of 75%, and the bile duct with an F1 score of 79% and sensitivity of 90%. Furthermore, ex vivo tumor tissue could be successfully detected with an area under the receiver operating characteristic (ROC) curve (AUC) larger than 0.91.This study demonstrates that intelligent HSI can automatically and accurately detect different tissue types. Despite great progress in the last decade intelligent HSI still has limitations. Thus, accurate AI algorithms that are easier to understand for the user and an extensive standardized and continuously growing database are needed. Further clinical studies should support the various medical applications and lead to the adoption of intelligent HSI in the clinical routine practice.HINTERGRUND: Intraoperative Bildgebung unterstützt Chirurgen bei minimal-invasiven Eingriffen. Die hyperspektrale Bildgebung („hyperspectral imaging“, HSI) ist ein nichtinvasives und kontaktloses optisches Verfahren mit großem diagnostischem Potenzial in der Medizin. Die Kombination mit Ansätzen der künstlichen Intelligenz (KI) für die Analyse der HSI-Daten wird in diesem Artikel intelligente HSI genannt.Wie kann intelligente HSI in der minimal-invasiven Viszeralchirurgie eingesetzt werden und wo liegen die Vorteile?Innerhalb verschiedener klinischer Studien wurden HSI-Daten mehrerer In-vivo-Gewebearten und onkologischer Resektate mit einer HSI-Kamera aufgenommen. Verschiedene KI-Algorithmen wurden zur Identifikation und Diskriminierung von Organen, Risikostrukturen und Tumoren evaluiert.Im Tierversuch konnten 20 verschiedene Organe mit hoher Genauigkeit ( 95 %) mittels KI differenziert werden. In-vivo konnten die Nebenschilddrüse mit einem F1-Score von 47 % und einer Sensitivität von 75 % sowie der Gallengang mit einem F1-Score von 79 % und einer Sensitivität von 90 % vom umliegenden Gewebe diskriminiert werden. Des Weiteren konnte Ex-vivo-Tumorgewebe mit einer Fläche unter der „Receiver-operating-characteristic“(ROC)-Kurve (AUC) größer als 0,91 erfolgreich erkannt werden.Die vorliegenden Arbeiten zeigen die Eignung intelligenter HSI zur automatischen Gewebeerkennung. Trotz großer Fortschritte in den letzten zehn Jahren zeigt intelligentes HSI noch Einschränkungen. So sind genauere und für den Benutzer verständlichere KI-Algorithmen sowie umfangreiche standardisierte und kontinuierlich wachsende Datenbanken notwendig. Weitere klinische Studien sollten die vielseitigen Anwendungen stützen und den Einsatz im klinischen Alltag fest etablieren.

Simple Summary Good oxygenation of both bowel ends is an important prerequisite to promote anastomotic healing after colorectal resections. Bowel oxygenation is usually assessed clinically. Hyperspectral imaging is a contactless and contrast-free tool that allows quantifying tissue oxygen intraoperatively. In this study, the results of 105 colorectal resections with hyperspectral imaging are reported. Abstract Background: A perfusion deficit is a well-defined and intraoperatively influenceable cause of anastomotic leak (AL). Current intraoperative perfusion assessment methods do not provide objective and quantitative results. In this study, the ability of hyperspectral imaging (HSI) to quantify tissue oxygenation intraoperatively was assessed. Methods: 115 patients undergoing colorectal resections were included in the final analysis. Before anastomotic formation, the bowel was extracted and the resection line was outlined and imaged using a compact HSI camera, in order to provide instantaneously quantitative perfusion assessment. Results: In 105 patients, a clear demarcation line was visible with HSI one minute after marginal artery transection, reaching a plateau after 3 min. In 58 (55.2%) patients, the clinically determined transection line matched with HSI. In 23 (21.9%) patients, the clinically established resection margin was entirely within the less perfused area. In 24 patients (22.8%), the HSI transection line had an irregular course and crossed the clinically established resection line. In four cases, HSI disclosed a clinically undetected lesion of the marginal artery. Conclusions: Intraoperative HSI is safe, well reproducible, and does not disrupt the surgical workflow. It also quantifies bowel surface perfusion. HSI might become an intraoperative guidance tool, potentially preventing postoperative complications.

The removal of film-like deposits is a challenge in many fields of production. For environmental and economic reasons, the cleaning processes need to be optimized. An optimization by means of computational fluid dynamics seems to be beneficial, but is subject to some restrictions, especially in industrial context. General modeling ideas, a subdivision into sub-processes and the significance of time dependent soil behavior are discussed as well as specific concepts related to four basic cleaning mechanisms, namely diffusive dissolution, cohesive separation, viscous shifting and adhesive detachment. Cleaning experiments in fully developed plane channel flow, resembling a simplified plate heat exchanger, are performed with model soils (starch, petroleum jelly, ketchup) which were chosen to represent an almost ideal form of one of the basic cleaning mechanisms.

Background: Novel intraoperative imaging techniques, namely, hyperspectral (HSI) and fluorescence imaging (FI), are promising with respect to reducing severe postoperative complications, thus increasing patient safety. Both tools have already been used to evaluate perfusion of the gastric conduit after esophagectomy and before anastomosis. To our knowledge, this is the first study evaluating both modalities simultaneously during esophagectomy. Methods: In our pilot study, 13 patients, who underwent Ivor Lewis esophagectomy and gastric conduit reconstruction, were analyzed prospectively. HSI and FI were recorded before establishing the anastomosis in order to determine its optimum position. Results: No anastomotic leak occurred during this pilot study. In five patients, the imaging methods resulted in a more peripheral adaptation of the anastomosis. There were no significant differences between the two imaging tools, and no adverse events due to the imaging methods or indocyanine green (ICG) injection occurred. Conclusions: Simultaneous intraoperative application of both modalities was feasible and not time consuming. They are complementary with regard to the ideal anastomotic position and may contribute to better surgical outcomes. The impact of their simultaneous application will be proven in consecutive prospective trials with a large patient cohort.

Background Hyperspectral imaging (HSI) during surgical procedures is a new method for perfusion quantification and tissue discrimination. Its use has been limited to open surgery due to large camera sizes, missing color video, or long acquisition times. A hand-held, laparoscopic hyperspectral camera has been developed now to overcome those disadvantages and evaluated clinically for the first time. Methods In a clinical evaluation study, gastrointestinal resectates of ten cancer patients were investigated using the laparoscopic hyperspectral camera. Reference data from corresponding anatomical regions were acquired with a clinically approved HSI system. An image registration process was executed that allowed for pixel-wise comparisons of spectral data and parameter images (StO2: oxygen saturation of tissue, NIR PI: near-infrared perfusion index, OHI: organ hemoglobin index, TWI: tissue water index) provided by both camera systems. The mean absolute error (MAE) and root mean square error (RMSE) served for the quantitative evaluations. Spearman’s rank correlation between factors related to the study design like the time of spectral white balancing and MAE, respectively RMSE, was calculated. Results The obtained mean MAEs between the TIVITA® Tissue and the laparoscopic hyperspectral system resulted in StO2: 11% ± 7%, NIR PI: 14±3, OHI: 14± 5, and TWI: 10 ± 2. The mean RMSE between both systems was 0.1±0.03 from 500 to 750 nm and 0.15 ±0.06 from 750 to 1000 nm. Spearman’s rank correlation coefficients showed no significant correlation between MAE or RMSE and influencing factors related to the study design. Conclusion Qualitatively, parameter images of the laparoscopic system corresponded to those of the system for open surgery. Quantitative deviations were attributed to technical differences rather than the study design. Limitations of the presented study are addressed in current large-scale in vivo trials.

Discrimination of malignant and non-malignant cells of histopathologic specimens is a key step in cancer diagnostics. Hyperspectral Imaging (HSI) allows the acquisition of spectra in the visual and near-infrared range (500-1000nm). HSI can support the identification and classification of cancer cells using machine learning algorithms. In this work, we tested four classification methods on histopathological slides of esophageal adenocarcinoma. The best results were achieved with a Multi-Layer Perceptron. Sensitivity and F1-Score values of 90% were obtained.

Do expansive body postures increase self-esteem in children? Power posing is a popular but also controversial topic. Still, there has been no research on the possible effects in children. To investigate the influence of power posing in children, 108 German fourth graders were randomly assigned to a high versus a low power posing group. Self-esteem was self-reported; feelings were assessed indirectly. There was an effect of power posing on self-reported global and school self-esteem. Furthermore, children who had performed high power poses in comparison with those who had performed low power poses mentioned more positive feelings, higher power feelings, and a more positive student–teacher relationship. Results are interpreted with regard to the context and the cultural dependency of the power posing effect. Implications for school practice are addressed.

Fluorescence angiography (FA) with indocyanine green (ICG) and hyperspectral imaging (HSI) are novel intraoperative visualization techniques in abdominal, vascular and transplant surgery. With the purpose of precision surgery, and in order to increase patient's safety, these new tools aim at reducing postoperative morbidity and mortality. This review discusses and highlights recent developments and the future potential of real-time imaging modalities.The underlying mechanisms of the novel imaging methods and their clinical impact are displayed in the context of avoiding anastomotic leaks, the most momentous complications in gastrointestinal surgery after oncologic resections.While FA is associated with the admission of a fluorescence agent, HSI is contact-free and non-invasive. Both methods are able to record physiological tissue properties in real-time. Additionally, FA also measures dynamic phenomena. The techniques take a few seconds only and do not hamper the operative workflow considerably. With regard to a potential change of the surgical strategy, FA and HSI have an equal significance. Our own advancements reflect, in particular, the topics of data visualization and automated data analyses together with the implementation of artificial intelligence (AI) and minimalization of the current devices to install them into endoscopes, minimal-invasive and robot-guided surgery.There are a limited number of studies in the field of intraoperative imaging techniques. Whether precision surgery in the "high-tech" OR together with FA, HSI and robotics will result in more secure operative procedures to minimize the postoperative morbidity and mortality will have to be evaluated in future multicenter trials.Die Fluoreszenz-Angiografie (FA) mit Indocyanin-Grün (ICG) und das Hyperspektral-Imaging (HSI) sind neue intraoperative Visualisierungsmöglichkeiten in der Abdominal-, Gefäß- und Transplantationschirurgie. Ziel ist es, damit die postoperative Morbidität und Mortalität im Sinne der Präzisionschirurgie und Patientensicherheit zu reduzieren. In diesem Artikel werden aktuelle Daten und das zukünftige innovative Potenzial der Echtzeit-Bildgebungsmodalitäten hervorgehoben.Das Prinzip der neuen „Imaging“-Verfahren und deren klinische Anwendungen werden aufgearbeitet mit Blick auf Anastomoseninsuffizienzen, die die folgenschwersten Komplikationen in der gastrointestinalen Chirurgie nach onkologischen Resektionen darstellen.Während die FA die Gabe eines Fluoreszenzfarbstoffs erfordert, ist HSI völlig kontaktfrei und nichtinvasiv. Beide Methoden können in „Real-Time“-Applikation physiologische Gewebeeigenschaften, zudem die FA auch dynamische Phänomene, erfassen. Die Verfahren dauern nur wenige Sekunden und stören den operativen Ablauf nicht wesentlich. Sie sind hinsichtlich ihrer Aussagekraft für eine mögliche Änderung der operativen Strategie als komplementär zu betrachten. Unsere eigenen Weiterentwicklungen der Modalitäten liegen insbesondere im Bereich der Datenvisualisierung sowie der automatischen Datenanalyse unter Einsatz der künstlichen Intelligenz (KI) und der Miniaturisierung der bisherigen Geräte für einen zukünftigen Einsatz in der Endoskopie, der minimalinvasiven und der roboterassistierten Chirurgie.Insgesamt ist die Zahl der Studien im Forschungsfeld der intraoperativen Bildgebung zurzeit noch sehr limitiert. Ob diese neue Art der Präzisionschirurgie im „Hightech“-OP mit der Kombination aus HSI, FA und Robotik zu einer verbesserten Patientensicherheit durch Minimierung der postoperativen Morbidität und Mortalität führt, muss in weiterführenden multizentrischen Studien evaluiert werden.

Oncologic visceral surgery has recently been revolutionized by robotics, artificial intelligence (AI), sparing of functionally important structures and innovative intraoperative imaging tools. These techniques enable new dimensions of precision surgery and oncology. Currently, data-driven, cognitive operating rooms are standing at the forefront of the latest technical and didactic developments in abdominal surgery. Rectal low anterior resection with total mesorectal excision (TME) for lower- and middle-third rectal cancer is a challenging operation due to the narrow pelvis and the tender guiding structures. Thus, new approaches have been needed to simplify the procedure and to upgrade the results. The combination of robotics with pelvic intraoperative neuromonitoring (pIONM) and new possibilities of visualization, such as multi- and hyperspectral imaging (MSI / HSI) or fluorescence imaging (FI) with indocyanine green (ICG) is a forward-looking modality to enhance surgical precision and reduce postoperative complications while improving oncologic and functional outcomes with a better quality of life. The aim of our video-paper is to show how to achieve maximum precision by combining robotic surgery with pelvic intraoperative neuromonitoring and new imaging devices for rectal cancer.

Esophageal cancer is the sixth leading cause of cancer-related death worldwide. Histopathological confirmation is a key step in tumor diagnosis. Therefore, simplification in decision-making by discrimination between malignant and non-malignant cells of histological specimens can be provided by combination of new imaging technology and artificial intelligence (AI). In this work, hyperspectral imaging (HSI) data from 95 patients were used to classify three different histopathological features (squamous epithelium cells, esophageal adenocarcinoma (EAC) cells, and tumor stroma cells), based on a multi-layer perceptron with two hidden layers. We achieved an accuracy of 78% for EAC and stroma cells, and 80% for squamous epithelium. HSI combined with machine learning algorithms is a promising and innovative technique, which allows image acquisition beyond Red–Green–Blue (RGB) images. Further method validation and standardization will be necessary, before automated tumor cell identification algorithms can be used in daily clinical practice.

Highlights • First case of HSI and ICG in Acute mesenteric ischemia. • Similar results of moth modalities with regard to well perfused intestine. • ICG shows exact vascular blood supply and intestinal perfusion. • Hyperspectral imaging can distinguish necrotic and vital intestinal segments in AMI. • Combined use helps surgeons to evaluate intestinal perfusion intraoperatively in AMI., Introduction and importance Acute mesenteric ischemia is a challenging acute condition which is often caused by occlusion of an intestinal vessel. Therapeutic algorithms include revascularization of the occluded vessel and a surgical procedure to remove necrotic intestine. Sometimes necrotic intestine is hard to identify visually. Therefore, tools such as hyperspectral imaging (HSI) and indocyanine green fluorescence angiography (ICGFA) might be helpful for objective intraoperative evaluation of intestinal perfusion. Case presentation We present a case of an 80-year-old woman with an acute superior mesenteric artery occlusion and subsequent intestinal gangrene. After endovascular arterial revascularization, we performed an explorative laparotomy in which we assessed intestinal perfusion by HSI and ICGFA. Both HSI and ICGFA showed a sharp perfusion borderline in the proximal jejunum. The distal intestine showed low tissue oxygenation (HSI) and inhomogeneous perfusion (ICGFA). Clinical discussion Both methods showed reproducible results for tissue perfusion and, thus, could provide additional information on the extent of necrotic bowel with need for resection. Therefore, both modalities might be used in future image-guided surgery in cases of acute mesenteric ischemia where visual discrimination of intestinal perfusion is challenging in order to resect as much bowel as necessary to improve patient outcome. Both methods exert different strengths: i.e. ICGFA is real-time angiography, whereas HSI may expose intestinal necrosis in spectroscopy. Conclusion We show, for the first time, simultaneous imaging of HSI and ICGFA in a case of acute mesenteric ischemia. Both imaging modalities reveal similar results reliably concerning intestinal perfusion.

The surgical treatment of gastric cancer has arrived at a turning point towards the routine application of minimally invasive techniques. After the first results of prospective randomized trials from Asia confirmed the surgical and oncological safety, the latest results of international trials provided evidence for minimally invasive gastrectomy of advanced gastric cancer in a multimodal setting. A new addition in the field of minimally invasive procedures is robotic-assisted surgical techniques, which have already been implemented for these indications in many centers in Germany. The technical advantages that are applicable in the robotics setting in comparison to laparoscopy lead to a rapid dissemination of the procedure but still need to be evaluated in controlled trials. Further developments for the surgical treatment of gastric cancer are found in the field of intraoperative imaging procedures. In this field various technologies are available, such as fluorescence imaging using a near-infrared camera, which requires the use of a fluorescent agent or the hyperspectral camera system, which does not require the application of a fluorophore and merges pictures from visible and non-visible wavelengths to a functional image. It is to be expected that in the future various technological advancements can make a valuable contribution to the surgical treatment of gastric cancer in the clinical routine, especially if they support and facilitate the use of minimally invasive surgical techniques.Die chirurgische Therapie des Magenkarzinoms befindet sich an einem Wendepunkt hin zur routinemäßigen Verwendung minimal-invasiver Techniken. Nachdem erste Ergebnisse asiatischer prospektiv-randomisierter Studien die chirurgische und onkologische Sicherheit belegt haben, besteht mittlerweile auch internationale Evidenz für die minimal-invasive Gastrektomie beim fortgeschrittenen Magenkarzinom im multimodalen Setting. Neu im Bereich der minimal-invasiven Verfahren sind robotisch-assistierte Techniken, die bereits in etlichen Zentren in Deutschland bei dieser Indikation eingesetzt werden. Die technischen Vorteile, die sich im robotischen Setting im Vergleich zur Laparoskopie ergeben, führen zu einer zügigen Verbreitung des Verfahrens, müssen aber noch in kontrollierten Studien bewertet werden. Weitere Entwicklungen auf dem Gebiet der Chirurgie des Magenkarzinoms finden sich im Bereich intraoperativ bildgebender Verfahren. Hier stehen verschiedene Technologien zur Verfügung, wie die Fluoreszenzbildgebung mit Nutzung einer Nahinfrarotkamera und eines Fluoreszenzfarbstoffs oder die Hyperspektralkamera, die ohne Applikation eines Fluorophors weite Bereiche des sichtbaren und nichtsichtbaren Lichts zu funktionellen Bildern fusioniert. Es ist davon auszugehen, dass für die chirurgische Therapie des Magenkarzinoms verschiedene technologische Weiterentwicklungen zukünftig einen wertvollen Beitrag in der klinischen Routine leisten können, insbesondere wenn diese die Verwendung minimal-invasiver Operationstechniken unterstützen und vereinfachen.

Currently, colorectal cancer (CRC) is mainly identified via a visual assessment during colonoscopy, increasingly used artificial intelligence algorithms, or surgery. Subsequently, CRC is confirmed through a histopathological examination by a pathologist. Hyperspectral imaging (HSI), a non-invasive optical imaging technology, has shown promising results in the medical field. In the current study, we combined HSI with several artificial intelligence algorithms to discriminate CRC. Between July 2019 and May 2020, 54 consecutive patients undergoing colorectal resections for CRC were included. The tumor was imaged from the mucosal side with a hyperspectral camera. The image annotations were classified into three groups (cancer, CA, adenomatous margin around the central tumor, AD, and healthy mucosa, HM). Classification and visualization were performed based on a four-layer perceptron neural network. Based on a neural network, the classification of CA or AD resulted in a sensitivity of 86% and a specificity of 95%, by means of leave-one-patient-out cross-validation. Additionally, significant differences in terms of perfusion parameters (e.g., oxygen saturation) related to tumor staging and neoadjuvant therapy were observed. Hyperspectral imaging combined with automatic classification can be used to differentiate between CRC and healthy mucosa. Additionally, the biological changes induced by chemotherapy to the tissue are detectable with HSI.